- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $6,760.83
| Facility | | $1,737.80 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $7,943.28
| Facility | | $1,659.59 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $3,019.95
| Facility | | $776.25 | $1,000.00 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $389.05
| Facility | AS | $208.93 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,995.26 / $4,677.35
| Facility | | $977.24 | $1,995.26 | $4,677.35 |